Home Health & Hospice Week

Claims system glitches, COPs, CAHPS also addressed in Open Door Forum.

In case you didn’t notice it in Medicare’s announcement about the new OASIS-C1 implementation date, you’ll have some OASIS submission downtime during the transition from the current assessment form to the new one.

Last month, the Centers for Medicare & Medicaid Services announced a new Jan. 1 deadline for the OASIS-C1 form and accompanying  Assess-ment Submission and Processing (ASAP) system (see Eli’s HCW, Vol. XXI, No. 19). The so-called “OASIS-C1/ICD-9 Version” will omit changes to the diagnosis code-related M0 items, thanks to the ICD-10 implementation delay to October 2015, noted CMS’s Caroline Gallaher in the May 28 Open Door Forum for home care providers.

From 6 p.m. ET on Dec. 26, 2014 through 11:59 p.m. on Dec. 31, 2014, no OASIS assessments will be accepted, Gallaher emphasized in the forum. The ASAP system will become available at midnight on the last day of the year. “If you have OASIS assessments that you did not submit by Dec. 26, 2014, you can then submit them on or after Jan. 1, 2015,” Gallaher instructed. “However, you must submit them using the ASAP system.”

Remember: You’ll need to concurrently use version 2.10 of the ASAP system to submit OASIS-C assessments and version 2.11 for OASIS-C1 assessments, she reminded attendees.

Watch CMS’s OASIS-C1 page for the new, modified OASIS-C1/ICD-9 version form, data specs, and other forthcoming information.

Mark your calendar: CMS has rescheduled its OASIS-C1 training webinar for Sept. 30 at 2 p.m. ET, announced CMS’s Pat Sevast. Watch for a new survey & certification letter with details on how to dial in. 

The call will have about 1,000 lines on a first-come first-served basis, Sevast reminded agencies. Call in 20 to 30 minutes prior to the start time for the best chance of securing a line, she recommended. CMS will post the webinar on its website a few weeks after it takes place.

Other home health agency issues addressed in the forum include:

• Claims processing errors. CMS fixed one payment system glitch it reported in May, but another remains unresolved, revealed CMS’s Wil Gehne. “Claims with HIPPS [code] 3AGP are being paid correctly as of this time,” Gehne said. Formerly, the claims system was assigning an incorrect case mix weight to these claims, resulting in underpayments (see Eli’s HCW, Vol. XXI, No. 17).

But the system is still failing to pay low payment utilization adjustment (LUPA) add-ons for some claims that are supposed to receive those payments. “We are going to be issuing new software to correct the … problem,” Gehne said.

When both corrections are successful, Med-icare Administrative Contractors will adjust claims and make any repayments necessary, Gehne added. That’s likely to occur this month, he estimated.

• CAHPS. Waste no time notifying your CAHPS vendor if you have trouble submitting a monthly patient file to it, emphasized CMS’s Lori Teichman in the forum. If you are unable to submit a monthly file, your survey vendor will document this in an HHCAHPS discrepancy notification report that goes to CMS, she explained. “We use these forms when we consider whether or not HHAs have met the HHCAHPS requirements for the annual payment update determinations,” she continued.

• Reimbursement manual updates. Don’t get nervous when CMS issues a new reimbursement transmittal, Gehne assured forum participants. Forthcoming Change Request (CR) 8775 will revise the home health claims processing chapter, Chapter 10, of the Medicare Claims Processing Manual.

The update is merely “routine manual maintenance,” Gehne assured. “There’s no new policies or procedures contained in there.”

For example: The transmittal will remove from the Manual outdated references to the Home Health Advance Beneficiary Notice. Last December, CMS replaced the HHABN with a combination of the regular ABN (R131) and the new Home Health Change of Care Notice (10280).

• COPs. Don’t forget that patients served by your Medicare-certified HHA are still subject to Medicare conditions of participation, Sevast said in the question-and-answer portion of the call. “Any patient served by your provider — Medicare, managed care, Medicaid, private insurance — falls under the conditions of participation,” Sevast told an agency from California. “The surveyors would survey the entire agency.”